Initial graft tension has been considered one of the most important factors for clinical results after anterior cruciate ligament reconstruction. However, the optimal tension is not unknown.

In our study, there were no statistically significant differences within 8–15 kgf (78.5–147.1 N). This study suggests that 8 kgf tension is not extremely low, and 15 kgf tension is not excessively high.

At the time of surgery, we select 8 kgf tension because the 8 kgf group tended to have better clinical results.

Some ex vivo studies have demonstrated that higher initial tension had adverse consequences. These biomechanical studies were performed in cadaver or animal model. But after the surgery, a viscoelastic creep phenomenon reduces the initial tension in vivo. It is unknown how postoperative graft tension changes with time. We concluded that initial graft tension, of within 8–15 kgf, has little influence on the postoperative clinical outcome.